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General NPI Number Information
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NPI Number | 1780318014
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Entity Type | Individual
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Provider Name | DOMINIQUE GISELE GUILLAUME MSN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD STE A406
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City | BOWIE
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State | MD
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Zip | 20716-3139
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Country | US
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Telephone | 301-262-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 31 N STREEPER ST
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City | BALTIMORE
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State | MD
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Zip | 21224-1250
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Country | US
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Telephone | 770-561-7965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R215205
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN256248
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License Number State | GA
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